title: Impact of a diabetes control and management intervention on health care utilization in American Samoa.
abstract: OBJECTIVE
  To examine the impact of a successful 12-month behavioral intervention to improve diabetes control on health care utilization in American Samoa.
  
  
  METHODS
  A cluster-randomized design was used to assign 268 diabetes patients to a nurse-community health worker intervention or usual care. Hospitalizations, emergency department, and primary care physician visits were collected retrospectively for 1 year prior to, and during, the intervention to assess changes in health care utilization. The association of utilization changes with change in HbA1c during the intervention was assessed.
  
  
  RESULTS
  Adjusted incidence rate ratios (RR) for primary care physician visits were significantly higher in the community health worker relative to the usual care group (RR = 1.71; 95% CI, 1.25-2.33). There was no main intervention effect on emergency department utilization, but visits in the prior year modified the intervention effect on emergency department visits. Increased primary care physician utilization was associated with greater decreases in HbA1c (b = -0.10, SE = 0.04, p = 0.01).
  
  
  CONCLUSIONS
  A culturally adapted community health worker diabetes intervention in American Samoa significantly increased primary care physician visits, and decreased emergency department visits among those with high emergency department usage in the prior year. These changes suggest important and beneficial impacts on health system utilization from the diabetes intervention in a low resource and high-risk population.
authors.affiliation: 1MPH Program, Yale University School of Public Health, New Haven, CT, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hamid
authors.forename: Shira
authors.initials: S
authors.lastname: Dunsiger
authors.forename: Andrew
authors.initials: A
authors.lastname: Seiden
authors.forename: Ofeira
authors.initials: O
authors.lastname: Nu'usolia
authors.forename: John
authors.initials: J
authors.lastname: Tuitele
authors.forename: Judith D
authors.initials: JD
authors.lastname: DePue
authors.forename: Stephen T
authors.initials: ST
authors.lastname: McGarvey
mesh_terms: D000328:Adult; D018948:American Samoa; D003152:Community Health Nursing / Q000458:organization & administration; D003150:Community Health Workers / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000451:nursing*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin
keywords: Health care utilization; Samoans; community health workers; diabetes intervention; primary caress